© 2018 Ramírez-Palacios et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Research and Reports in Tropical Medicine 2018:9 49–62 Research and Reports in Tropical Medicine Dovepress submit your manuscript | www.dovepress.com Dovepress 49 ORIGINAL RESEARCH open access to scientific and medical research Open Access Full Text Article http://dx.doi.org/10.2147/RRTM.S144075 Molecular diagnosis of microbial copathogens with infuenza A(H1N1)pdm09 in Oaxaca, Mexico Luis Román Ramírez-Palacios 1 Diana Reséndez-Pérez 2 Maria Cristina Rodríguez-Padilla 2 Santiago Saavedra-Alonso 2 Olga Real-Najarro 3 Nadia A Fernández-Santos 4 Mario A Rodriguez Perez 4 1 Laboratorio Estatal de Salud Pública de Oaxaca, Oaxaca, 2 Departamento de Inmunología y Virología, Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico; 3 Consejería de Educación, Madrid, Spain; 4 Instituto Politécnico Nacional (IPN), Centro de Biotecnología Genómica, Reynosa, Mexico Background: Multiple factors have been associated with the severity of infection by influenza A(H1N1)pdm09. These include H1N1 cases with proven coinfections showing clinical associa- tion with bacterial contagions. Purpose: The objective was to identify H1N1 and copathogens in the Oaxaca (Mexico) popu- lation. A cross-sectional survey was conducted from 2009 to 2012. A total of 88 study patients with confirmed H1N1 by quantitative RT-PCR were recruited. Methods: Total nucleic acid from clinical samples of study patients was analyzed using a Tes- sArray RPM-Flu microarray assay to identify other respiratory pathogens. Results: High prevalence of copathogens (77.3%; 68 patients harbored one to three pathogens), predominantly from Streptococcus, Haemophilus, Neisseria, and Pseudomonas, were detected. Three patients (3.4%) had four or five respiratory copathogens, whereas others (19.3%) had no copathogens. Copathogenic occurrence with Staphylococcus aureus was 5.7%, Coxsackie virus 2.3%, Moraxella catarrhalis 1.1%, Klebsiella pneumoniae 1.1%, and parainfluenza virus 3 1.1%. The number of patients with copathogens was four times higher to those with H1N1 alone (80.68% and 19.32%, respectively). Four individuals (4.5%; two males, one female, and one infant) who died due to H1N1 were observed to have harbored such copathogens as Strep- tococcus, Staphylococcus, Haemophilus, and Neisseria. Conclusion: In summary, copathogens were found in a significant number (>50%) of cases of influenza in Oaxaca. Timely detection of coinfections producing increased acuity or severity of disease and treatment of affected patients is urgently needed. Keywords: bacteria, copathogens, microarray assay, H1N1 Introduction Influenza viruses A and B are the main pathogens responsible for the onset of epidemics because of their evolving nature. They are RNA viruses that have a high mutation rate and ability to make “drift” changes; however, only influenza A viruses are responsible for pandemics. Worldwide, influenza A viruses are the cause of severe infections in 3–5 million people annually, and these viral infections kills 0.25–0.5 million people annually. 44 As such, influenza outbreaks produce high morbidity and mortality rates with great economic and social impact. 44 Early findings in relation to the most recent influenza pandemic occurred in April 2009 in Mexico and soon spread to other countries. The pandemic was caused by an H1N1 variant, which came from two genetic recombination events. The first occurred in 1998, when an avian virus, an American pig virus, and virus fragments of humans had exchanged genetic materials. The following recombination with a European swine Correspondence: Mario A Rodriguez Perez Instituto Politécnico Nacional (IPN), Centro de Biotecnología Genómica, Boulevard del Maestro Esquina Elías Piña, Colonia Narciso Mendoza, Reynosa, Tamaulipas 88710, Mexico Email drmarodriguez@hotmail.com Research and Reports in Tropical Medicine downloaded from https://www.dovepress.com/ by 54.162.69.248 on 23-May-2020 For personal use only. 1 / 1